Provider Demographics
NPI:1073067021
Name:DOLLANI, REZEARTA
Entity Type:Individual
Prefix:
First Name:REZEARTA
Middle Name:
Last Name:DOLLANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16024 MANCHESTER RD
Mailing Address - Street 2:STE 200
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2195
Mailing Address - Country:US
Mailing Address - Phone:314-287-9186
Mailing Address - Fax:314-274-6366
Practice Address - Street 1:16024 MANCHESTER RD
Practice Address - Street 2:STE 200
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2195
Practice Address - Country:US
Practice Address - Phone:314-287-9186
Practice Address - Fax:314-274-6366
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009019350251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health